NE IA FCA Camp Scholarship Form

NE IA FCA Camp Scholarship Form
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of birth*

MonthDayYear
Date
Are you applying for our Sports Camp in Pella or our Discipleship Camp in Mount Vernon?*
Select grade will you be going into this Fall if you are applying for the Pella Sports Camp Scholarship

9th grade10th grade11th grade12th grade
Select grade will you be going into this Fall if you are applying for the Mount Vernon Discipleship Camp Scholarship

10th grade11th grade12th gradeGraduated Senior
Have you regularly attended your school's FCA huddle this year?*

YesNo
Are you on the FCA Student Leadership team this year?*

YesNo
How many years have you been a member of your school's FCA huddle?*
Have you attended an FCA sponsored camp before?*

YesNo
Share a little about your experience with FCA. How has FCA huddles or camps affected your walk with Christ?*
Other Circumstances
In the space below please describe any circumstances (past, present, or future) that you feel increase your qualification and/or need for a camp scholarship (e.g., family circumstances, academic standing, ministry or other responsibilities; etc.).
Student Signature*

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Date*

MonthDayYear
Date
Guardian/Parent Signature*

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Guardian/Parent email*
example@example.com
Should be Empty:

Other Circumstances